Provider Demographics
NPI:1235291618
Name:LIFEGUARD INTEGRATIVE PHARMACIES, INC.
Entity Type:Organization
Organization Name:LIFEGUARD INTEGRATIVE PHARMACIES, INC.
Other - Org Name:HEALTH FIRST PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT AND CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:BURGER
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:707-837-7948
Mailing Address - Street 1:9070 WINDSOR RD
Mailing Address - Street 2:
Mailing Address - City:WINDSOR
Mailing Address - State:CA
Mailing Address - Zip Code:95492-9701
Mailing Address - Country:US
Mailing Address - Phone:707-837-7948
Mailing Address - Fax:707-837-7949
Practice Address - Street 1:9070 WINDSOR RD
Practice Address - Street 2:
Practice Address - City:WINDSOR
Practice Address - State:CA
Practice Address - Zip Code:95492-9701
Practice Address - Country:US
Practice Address - Phone:707-837-7948
Practice Address - Fax:707-837-7949
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-14
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHY467393336C0003X, 3336C0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Not Answered3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA5613561OtherNCPDP
CAPHY46739OtherPHARMACY LICENSE
CABH8842925OtherDRUG ENFORCEMENT